Concurrent psychiatric, somatic, and social vulnerabilities in patients at increased cardiovascular risk in the Netherlands

OBJECTIVE: To evaluate clinical, psychiatric, demographic, and socioeconomic vulnerability in a Dutch primary care setting.

METHODS: We included 34,392 patients aged 40-70 years who were registered for cardiovascular risk management in general practice before 2018. Latent class analysis was performed using 17 indicators across seven themes: somatic morbidity, adverse lifestyle, psychiatric, age, sex, ethnicity, and socioeconomic factors. We compared five-year risk of major adverse cardiovascular events using Fine-Gray competing risk models and assessed annual medical expenditures (2018-2022) across the derived latent classes.

RESULTS: Clustering factors into four latent classes was considered optimal: class 1 (n = 6329; 18%), "mental and socioeconomic vulnerability"; class 2 (n = 11,888; 35%), "healthy and socioeconomic advantage"; class 3 (n = 4630; 13%), "senior and socioeconomic vulnerability"; class 4 (n = 11,545; 34%), "somatic burden and socioeconomic advantage". Class 1 had the highest cardiovascular risk after adjustment (subdistribution hazard ratio 1.52, 95% confidence interval 1.23, 1.87). It also showed the highest age-standardized mean expenditures: total (€5273), general practitioners (€253), and mental healthcare (€742).

CONCLUSIONS: Concurrent psychiatric disorders and socioeconomic deprivation increased cardiovascular risk. Cardiovascular risk management should be more integrated and person-centered to address multimorbidity, social determinants, and behavioral risk factors.